Inspection on 28/07/08 for Tower House II Residential Home

This inspection was carried out on 28th July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tower House II Residential Home 06/11/09

Tower House II Residential Home 03/06/09

Tower House II Residential Home 24/05/07

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Tower House II Residential Home 11 Tower Road Willesden London NW10 2HP Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 28th July 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tower House II Residential Home Address 11 Tower Road Willesden London NW10 2HP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8621 0399 Mary Christabell Chongo Mundy Position Vacant Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 3 7th February 2008 Date of last inspection Brief Description of the Service: Tower House II is located in Tower Road off Pound Lane in Willesden. It is easily accessible by cars and public transport. Buses serve Pound Lane and the home is about five minutes walk from the bus stop. There is a small parking area in front of the home for about 2 cars. Parking on the road is for residents only. The home was registered on the 11th January 2007 for three elderly residents of mixed gender who require personal care. It consists of a semi-detached House. There is a kitchen, lounge/dining area and a bedroom on the ground floor and two bedrooms and a bathroom on the first floor. All bedrooms are ensuite with a toilet and washbasin. There are pleasant garden/patio areas in front of the home and at the back that are very well maintained. The first floor is reached by a set of stairs and at the time of the inspection, the residents accommodated on the first floor were able to negotiate the stairs. Tower House II is own by Ms Mary Mundy. She has another care home next to Tower House II at number 9 and 10. There are a lot of interactions between the two homes and many activities are shared as they are next to each. The home charges £560 weekly and also accommodates residents who are publicly funded. They do not have to pay a top-up. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 5 There were 3 residents in the home at the time of the inspection. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. This report contains the findings of the key inspection of Tower House II for the period 2008-2009. It was unannounced and started on Monday 28th July at 10:00 and finished on the same day at 16:15. We visited the home in February 2008 to carry out a random inspection of the service following an anonymous complaint. The findings of this inspection are in a report that is available upon request to the Commission. The inspection took place at the same time as the inspection for Tower House I. As Tower House I and Tower House II are run in a very similar manner, the inspection of both services were carried out on the same day and some of the findings for both services were shared, as many of the arrangements in the home are the same. The manager completed an Annual Quality Assurance Assessment (AQAA), which was forwarded to the Commission in a timely manner. The AQAA was on the whole appropriately completed and was used were possible to inform this report. During the inspection we toured some of the premises, looked at a sample of records and spoke to two residents and one member of staff. We received three comment cards from residents. Whilst it was clear that one of the comment cards was completed by a resident, it was not clear who completed/supported residents with the other comment cards. Four comment cards from health and social care professionals were received, one of which was not named and it was not clear where another was from. One comment card from a relative was returned but it was not named. We therefore could only use part of the comment cards that were received for feedback about the service. We would like to thank the residents for a kind welcome into their home and the manager and all her staff for their assistance and support during the inspection. What the service does well: Comment cards showed that the residents were satisfied with the care that they receive and with the support that they receive in their daily lives. We also Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 7 found that residents presented as clean, appropriately dressed and appeared appropriately cared for. The home has the necessary facilities to make sure that new residents if referred to the home will be provided with enough information for them to make an informed decision about choosing the home. Although there have not been any new residents since the last inspection, we can however conclude f from evidence seen during the inspection, that residents’ needs will be appropriately assessed before they are offered a place in the home. The environment that the home provides is of a very good standard. The grounds are well maintained and provide pleasant areas that can be enjoyed by residents. The home is kept clean and free of odours. It is well maintained and provides a homely environment for residents. Residents are free to bring their personal possessions to personalise their bedrooms. What has improved since the last inspection? What they could do better: An action plan was received from the home in April 08 following the random inspection in February 2008. According to the action plan, the home had met all the eighteen requirements that were imposed on the service. During this inspection we however found evidence that many of these requirements have not been met. Imposed requirements must be met, as the Commission will enforce requirements that are not met within the appropriate timescale. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 8 Regulation 5 of the Care Homes Regulation 2001 (as amended 2006) requires that the service users’ guide contain information about the range of fees that is charged by the home for people to have all the necessary information before making a decision to move into the home. This has not yet been met. A number of risk assessments that are in use in the home are not reviewed at least monthly or when there are changes in residents’ condition. A few residents did not have all the necessary risk assessments. As a result residents may have needs that have not been identified and addressed. Although the care records are kept in residents’ room, staff could be more proactive by discussing the content of the care records with residents and recording their discussion. The home must keep a record of the care that is given to residents on a daily basis and on every shift. This will show how the care plans are being implemented and the condition of residents on a day to day basis. Similarly records must be kept when residents are seen by the relevant healthcare professional. Without the records it may be difficult to find out about the outcome of the visit by healthcare professionals in relation to the care of the resident. Medicines management was not always carried out safely. Some medicines were administered at too short an interval. This may be putting residents at risk. The actual amount of medicines that is administered in cases when a variable dose of medicine is prescribed must be recorded. The home did not have enough people who were trained to administer medicines. This must be addressed as soon as possible as this may be putting residents at risk. Whilst we noted some improvement in the provision of activities in the home with the recruitment of a part-time activities coordinator, we found that more could be provided particularly with regards to outings. The provision of meals in the home could also be improved to make sure that this reflects the choices of residents. Appropriate records must also be kept to evidence this. A few areas of improvement were noted with the environment such as with the provision of grab handles around toilets to promote the independence of people with impaired mobility. We did not find evidence that the bath hoists were being checked for safety as required. The window restrainers that have been fitted to the windows could be easily disabled, defeating the purpose of fitting a window restrainer. Although the proprietor of the home is very involved in the management of the home, the home does not have a registered manager to make sure that the aims and objectives of the service are being met as required. This must be addressed as soon as possible so that a person is identified who will have legal responsibility with the proprietor to ensure compliance with care home legislation, as enshrined by the minimum standards. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 9 The home has all the necessary resources to use to measure the quality of the service, but these are not being used as required for the self- assessment of the quality of the service. Whilst there is little input of the home in the management of the personal money of residents, more could be done to safeguard the possessions and valuables of residents by keeping good records about all the possessions that are brought into the home by residents. The home must take health and safety issues more seriously and must address all the deficits that have been noted during this inspection. This must be addressed to make sure that all people who use the service are safe. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-4 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has most of the necessary information to offer to people who want to use the service, for them to decide if they would like to move into the home. The home has the resources to make sure that the needs of residents will be appropriately assessed before the residents are offered a place. EVIDENCE: We noted that the service users’ guide (SUG) and the statement of purpose have been recently updated. The home was in the process of recruiting for a new manager and has therefore reviewed these documents. We however did not find information about the range of fees that are charged by the home. The home has not had any new residents since the last inspection so were not able to check how much information prospective residents receive to choose the home. However we did find a copy of the SUG in the care records of each resident and we therefore concluded that residents would be provided with information about the service to decide if they would like to move in the home. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 12 The care records are fully accessible to residents as they kept in the bedrooms of residents. Care records also contained copies of the home’s contract that have been offered to residents to inform them of their rights and obligations as residents in the home. These were signed either by residents or by their representatives where possible. There were copies of preadmission assessment of the needs of residents prior to them being offered a place in the home. We saw two preadmission assessments that were carried out by the proprietor and found that they were completed to a good standard. Copies of the needs assessments of the funding authorities were also available for inspection to provide more information about the needs of residents. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are not always reviewed monthly to make sure that these continue to address the changing needs of residents. Due to the lack of records it is not possible to say whether residents are seen regularly by the various healthcare professionals. Medicines’ management is not good enough to make sure that residents are safe at all times. The care records do not address the hopes and fears of residents and do not take their wishes and instructions about end of life care, into consideration. EVIDENCE: We looked at the care records of two residents. The records were kept in the residents’ room and therefore should be easily accessible to them. However, although this was the case there was no evidence of the involvement of the residents or of their representatives in their care records and it was not clear if staff had supported the residents in understanding their care plan. The manager stated that the third resident, whose care records were not inspected, has been involved in the care planning process. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 14 Care plans were reviewed monthly but we noted that risk assessments were not always reviewed monthly. There were a number of risk assessments in use in the home such as pressure ulcer, nutritional, manual handling and falls risk assessments. One resident’s pressure sore risk assessment was reviewed in July 2007 then in June 2008. The fall risk assessment was reviewed in February 2007. We did not find a manual handling risk assessment for that resident. The other resident did not have a pressure ulcer risk assessment and a manual handling risk assessment. There were some other risk assessments such the risk of absconding and wandering. However we found out that these were not kept up to date and reviewed in line with the changing condition of the resident. Care plans to some extent addressed the religious and cultural needs of residents and the manager has introduced a life history form with more information about the backgrounds of residents. We however noted that care plans did not always addressed the hopes and the fears for the future of residents and their wishes and instructions with regards to end of life care. We looked at the progress records and noted daily entries were not always made to describe the condition of residents and the implementation of the care plans. We did not see many entries for night duty and it seemed that night staff did not always write about residents’ wellbeing and condition at night. We also noted that blue ink was used in many places when it is recommended that black ink be used for all records as they can more easily and clearly be photocopied. The poor standard of daily notes about residents’ condition is a major shortfall for the home. The proprietor stated that this would be addressed immediately. We were informed that all residents in the home were registered with a GP and feedback from the GP surgery was very good. The comment cards mentioned the good relation that exists between the home and the surgery, the professional approach of staff in the home as well as the good support that residents receive with their healthcare needs. We however could not find information about the outcomes of residents’ visit to the GP. We did not also see evidence that residents were seen regularly by other healthcare professionals such as the optician or the chiropodist. The manager clarified that staff cut the toenails of some residents. However for staff to cut the toes nails of residents it is important that they receive training for that, particularly when residents may have vascular or neurological problems or when they are diabetics. Residents were weighed monthly and we noted that care plans were in place in cases when residents were loosing weight. This was good practice. We found that the residents were appropriately dressed and groomed for the weather. The proprietor informed us that the residents normally stay in Tower Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 15 House II and that they normally go to Tower House I when there are special occasions, such as when there is something to celebrate or an activity to take part in. Comment cards received from residents showed that they were on the whole satisfied with the support that they receive from staff in the home. Medications were inspected. We found that some medications including paracetamol were given at 08:00, 14:00, 16:00 and 22:00. There was only a gap of two hours between 14:00 and 16:00. Some medicines including paracetamol must be given after four hours or more. If these are given earlier then this could cause an overdose of the medicine in the blood serum and could adversely affect residents. We also noted that the actual number of tablets of paracetamol given when one or two is prescribed to be given, was not always recorded. There were also creams with instructions that said ‘use as directed’. It was not clear what ‘as directed ‘ means to us. We asked about the training of staff in the administration of medicines. The manager replied that there are only two persons who administer medicines. She added that she had trained the other person to administer medicines, but we could not find any records where the competency of the member of staff was tested with regards to the management of medicines. The member of staff has also been in the home for a number of years and should have been offered certified training for the administration of medicines. She added that there is another person who works in another care home who comes to the home to administer medication. That person is not a member of staff and is not from the agency and therefore the accountability of that person and the liability of the home with regards to medicines administration and the action of that person are not clear. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The social and recreational needs of residents are appropriately assessed and recorded, but more could be done to ensure that these needs are fully met, such as by the provision of more outings and activities. There is insufficient evidence to show whether the meals that are provided are according to the choices of residents and whether these are sufficiently varied and nutritious. EVIDENCE: The proprietor showed us that she has started to compile a format for the life history of residents to bring a person centred perspective to care plans. The life histories were however at the back of the care plans instead of being in the front. They could have been made in a more interesting format with the involvement of the residents, and in an easier to read format, as they were completed in small size font. For example pictures/icons could have been used to present the life history of residents in a more interesting manner. We were informed that there is an activities coordinator who works both in Tower House I and II on Fridays and Saturdays. On Thursdays residents go to the day centres. The proprietor said that during the week staff carry out activities with the residents. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 17 We also noted residents sitting outside the home in the gardens. Some residents like sitting outside as they independently went to sit outside and others were encouraged by staff to sit outside. We however noted that the two residents in Tower House II sat by themselves for long periods as the person who was working in Tower House II was in Tower House I while the manager was with the inspector. We did not see any in-house activities for them. We saw that the television was on in the lounge, but the quality of the picture was poor because the TV had not been properly connected to the aerial. The manager has stated in the AQAA that the home now has cable television, but if this is not connected residents are unlikely to enjoy the TV programmes. We ask about outings for residents. We were informed that residents are able to go out and that staff accompany residents when they go out. On the day of the inspection, one of the resident was out with a member of staff. According to the proprietor outings are organised to shopping centres and that residents are taken once a week to the pub. The AQAA did not mention outings to places of interests such as a trip to the seaside and we saw little evidence of outings to places of interest. A resident’s friend said that if there were outings he would have been able to accompany the resident on the outings occasionally. The manager identified this as an area for improvement in the AQAA We were informed that a representative from the Roman Catholic Church visits residents on a Sunday afternoon and that the representative from the Church of England visits residents on a Monday afternoon. The proprietor added that the minister from the Baptist Church also visits the home to offer spiritual support to residents. The two homes tend to operate together with regards to the provision of meals. The manager said in the AQAA that there is a menu card system in the home. We indeed noted that the menu was in a pictorial and written format and included a selection of varied, wholesome meals. The menu was displayed upon the dining room table. However we found little evidence that the provision of meals in the home adhered to the meals that were on the menu card system. A senior staff member told us that this menu was not generally followed, and meals were decided usually on a daily basis, following consultation with people using the service. On the day of the inspection, the meals on the menu were not prepared but the proprietor got residents a ‘take-away’, which they were able to choose from a list. The proprietor stated that they plan to prepare the meal that they had planned for lunch on that day, for supper. There were no up to date records of food eaten by residents, nor evidence that people had choice with regard to their meals. Two residents informed us that Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 18 they generally did not have a choice about their meals and receive what they are ‘given’. We saw some fish defrosting in the sink. According to guidance from the Food Standards Agency, food must be thawed in a fridge to make sure that the food is totally thawed and that the food item does not get too warm, which can happen if the food is thawed outside a fridge and which can then lead to the food becoming bad and to an increased risk of food poisoning. We also noted a supply of some tins of food and some dried and frozen products. There were also some fresh vegetables and fruits. The manager clarified that if they need more products the shops are not far away. She added that the menu was not complied with, not because the home did not order food products according to the meals that were on the menu, but because staff asked residents about what they wanted to eat on the day, and often that is different from what is on the menu. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home takes complaints seriously and makes sure that these are appropriately investigated and addressed. The home ensures that staff in the home have an awareness of the safeguarding adult procedure to make sure that residents are safe. EVIDENCE: Since the last inspection there has been one anonymous complaint about the service that was first investigated by the manager then reviewed by the Commission. We found that the complaint was not substantiated but did find areas where improvement could be made. The complaint procedure is found in the service users’ guide and is accessible to residents. They all said in the comment cards that they knew how to make a complaint. The proprietor said in the AQAA that the home has a concern book and a suggestion book and that staff are involved in answering complaints. There have not been allegations of abuse about the service. There was evidence that some members of staff were given training on abuse. The proprietor uses a training agency and the local borough for this purpose. All new members of staff also receive induction as per skills for care with the training agency and we were informed that the staff receive an awareness of safeguarding adult during this process. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 20 The proprietor was aware of the need to report all allegations and suspicions of abuse to the local borough and to the Commission. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 and 26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides comfortable accommodation where residents needs can be appropriately met. EVIDENCE: The front of the home was attractively planted with trees and shrubs. There were many items of garden decorations. We also found the grounds to be tidy and that the exterior of the home appears was in good condition. The grounds at the back of the home were also appropriately maintained. There were patio areas, trees, shrubs, lawns as well as a vegetable patch. Residents sitting in the shade, that was provided by some trees and were seen enjoying these areas. The home was in an appropriate state of decoration and appropriate items of furniture were noted in the communal areas suitable for the number of residents that was accommodated in the home and for their needs. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 22 The bedrooms of residents were in a good state of decoration and continued to be homely. There was evidence that some residents brought their own belongings to the home to make their rooms more personalised. We noted that one resident had bought things that he placed in his room to make it more attractive. The door to the bathroom on the first floor now has a lock and thermostatic valves have been fitted to hot water outlets that residents have access to. Radiator covers have also been fitted to radiators that residents have access to, to make sure that residents were not at risk from the hot surfaces of the radiators. Restrainers have been fitted to windows to make sure that they do not open wide enough so that a person would be able to fall through. We however found that the restrainers could very easily be disabled. The home was on the whole clean and free from odours. There were alcoholic rub in some areas for staff to use as a quick way of disinfecting the hands. The home now has its own laundry (shared with Tower House I) where all the residents’ clothes and bed linen are washed and ironed. There are a commercial washing machine with sluicing facility and a commercial dryer. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 28-30 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The duty rosters were not kept sufficiently up to date to make a judgement whether staffing levels were adequate to meet the needs of residents who live in the home. The recruitment procedure was not robustly applied to ensure the safety of people who use the service. There were no records about the induction of new staff in the home. Staff did not receive training in a number of areas to make sure that they were competent in these areas. EVIDENCE: The manager stated that there are two members of staff during the day at all times. One at times goes out with residents when they go to day centres or out-patients appointments and the other member of staff stays in the home. At night there are one carer who ask for help from Tower House I if that is required. We checked the duty rosters and noted that this was what the duty rosters showed. However on further enquiries we found out that on the day of the inspection, a member of staff who should have been on duty was not on duty and instead an agency carer had been booked to cover the shift. On the day prior to the inspection one member of staff did a half-day, when her name was on for a full shift, and an agency staff was used for the other half of the day shift. We found that the duty roster had also not been updated to reflect this. As a result we concluded that the duty roster has not been updated to Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 24 reflect changes in the staffing team and the actual people who worked in the home. It is a statutory duty for the person who runs a care home to keep a record of whether the duty roster was actually worked. We looked at the personnel files of four members of staff. One was recruited prior to 2008 and the other three were recruited in 2008. Each had an application form that was generally well completed, except for one where the work history in the application form and in the attached CV was not given close to the month. As a result it was not possible to say whether there were gaps in the employment/education history and whether these were explored during the recruitment process. One member of staff did not have two references and another did not have a copy of the passport and the visa to show that he/she was eligible to work in the UK. However they all have had appropriate Criminal Records Bureau checks. The proprietor informed us that all new applicants receive induction about the home when they first start work. They also complete the common induction standards as per Skills for Care, through a training agency. Whilst the records were available to show that new members of staff were in the process of completing the Common Induction Standards, we noted that there were no records to show that they have had an induction about the home to cover areas such as its philosophy of care, its policies and procedures, introduction to the environment and action to take in an emergency. One member of staff started work at the end of March and had still not completed the common induction standards at the time of the inspection (end of July) when this induction should be completed within six weeks. It was noted that the member of staff who was recruited prior to 2008 was up to date with most of the statutory training except for medication training. The other members of staff have had training that has been organised by the training agency and covered food hygiene, manual handling and infection control, but not fire training, medication training and abuse training. We were informed that the abuse training is addressed during induction and will be provided when this is organised by the local Borough. According to the AQAA the home has fifteen care staff, out of which two have NVQ level 2. We later checked this with the proprietor and she confirmed that there are six members of staff for the home, including her (although her name was not on the duty roster) and that out of this number three had an NVQ qualification in care and one was a trained nurse. The home therefore does have 50 of its care staff trained to NVQ level 2 or above. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36 and 38 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home does not have a registered manager to ensure the smooth running of the home and compliance with legislation. The home has yet to apply quality control measures to make sure that it has a fully working self-assessment tool. The management of residents’ possessions could be made more robust to ensure the safety of these. A few health and safety issues were noted which could pose a risk to people who use the service. EVIDENCE: The home did not have a manager at the time of the inspection. An application that was put forward for a person to be the registered manager was not successful. There was evidence that the proprietor was continuing in the Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 26 process of recruiting a suitable manager for the service. In the meantime, she was overseeing the running of the home with the assistance of the deputy manager. Minutes of staff meetings and residents’ meetings were available for inspection. There has been a staff meeting in May 08 and the one prior to that was held in September 07. Similarly the last residents’ meeting was held in May 08 and the one prior to that was held in August 07. The proprietor said that the policy of arranging meetings state that the meetings should be arranged monthly. The home has a quality assurance procedure and there was evidence that it had the self-assessment format to carry out an audit of the standard of service that it provides. We however noted that the home has not yet used the audit format to carry out a self-assessment. There was also no report following a recent satisfaction survey to summarise the findings of the survey. As a result we concluded that whilst the home has the tools to measure the quality of the service, the tools have not yet been applied for this purpose. The proprietor stated that she did not manage the pocket of money of residents and was not the agent for any of the residents. These were managed either by residents themselves, their relatives or by the local authorities, which placed them into the home. She said that in the case of one resident whose money was managed by the local authority, things were purchased for the resident as and when needed and she then invoiced the local authority for the things that have been bought. We noted that there were records of the property and possessions that have brought into the home when residents were admitted. We checked the records and noted that these have not always been kept up to date when residents bought more things or when things were brought after admission, into the home for them. The records must be kept up to date as far as possible to ensure the safety of residents’ possessions. There was evidence that members of staff were receiving one to one supervision in the home but according to the records these were not always held every two months or six times a year. The home now has radiator covers for all the radiators that residents have access to. Thermostatic valves have also been placed at the hot water outlets to which residents have access. However there were no regular water temperature checks to make sure that the thermostatic valves were working properly. There were no records of weekly fire detector tests, but there were records of monthly emergency lights tests. There were also records of some daily safety checks. Fire drills were also conducted at about three monthly intervals. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 27 A PAT certificate test certificate and an electrical wiring test certificate were available for inspection. There was also an up to date gas safety certificate. We found that the fire risk assessment was dated January 07. According to the manager there was a fire emergency plan. The health and safety risk assessment was reviewed in December 2007 and it seemed to address safe working practices for staff but did not address risks that may be faced by residents. These included risks such as coming down the stairs, access to hot water, the window restrainers, and trips and hazards in the home and outside, in the grounds of the home. For example we found that there were raised door frames, which could be a trip hazard and many uneven surfaces in the garden where residents and other people could trip. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 2 Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 5 Requirement Timescale for action 30/09/08 2 OP7 15(2)(b) 3 OP7 17 4 OP7 15(2) The service users’ guide must contain information about the range of fees charged by the home and what is covered in the fees (Repeated requirementtimescale 31/03/08 not met). 30/09/08 That risk assessments and care plans are updated as and when the condition of residents changes to make sure that these reflect the needs of the residents. (Repeated requirement-timescale 31/03/08 not met). All risk assessments must be reviewed monthly. All residents must have a manual handling risk assessment to ensure safe transfers and moving. That a record is kept about the 31/08/08 day to day implementation of the care plans and of the care that residents receive on each shift that staff do. That evidence be kept about the 30/09/08 involvement of residents/representatives in drawing and reviewing the care DS0000068639.V365966.R01.S.doc Version 5.2 Tower House II Residential Home Page 30 5 OP8 17 6 OP8 18(1)(c) 7 OP9 13(2) 8 OP9 13(2) 9 OP9 13(2) 10. OP11 15(1,2) plans and risk assessments. Records must be kept about the outcomes of the visits when residents are seen by healthcare professionals such as the GP, optician, dentist and chiropodist. Staff who cut the toenails of residents must have the appropriate training to do so, particularly when residents have poor circulation, diabetes or vascular diseases. All members of staff that administer medicine must receive certificated training in this area. There must be more than two members of staff (for both homes) to make sure that the home has sufficient number of competent people to administer medicines. The administration of medicines by people who are not members of staff and who are not from an agency must be explored to make sure that accountability and insurance liability issues are addressed. That the time that is lapsed between each dose of medicines when these are prescribed to be given a number of times daily, be of equal intervals as far as possible and when this is indicated, to make sure that residents receive the full therapeutic effect of the medicine. The interval must be not be shorter than what is recommended as this could have detrimental side effects on the health of residents. The amount of medicines that is administered in cases of variable dose must be recorded to ensure appropriate monitoring of the effect of the medicine. Care plans must address the DS0000068639.V365966.R01.S.doc 31/08/08 31/10/08 30/09/08 31/08/08 31/08/08 30/09/08 Page 31 Tower House II Residential Home Version 5.2 11 OP15 16(2)(i) aspirations and future of residents as well as any wishes and instructions with regards to end of life care and death. (Repeated requirementtimescale 31/03/08 not met). The menu must be reviewed to reflect the choices of residents and once the menu has been agreed this must be adhered to as much as possible (Repeated requirement-timescale 31/03/08 not met). There must be a record of all food eaten by residents to enable a person inspecting the records make a judgment about the meals that are provided to residents with regards to variety and nutritional content and whether the meals meet residents’ dietary and cultural needs. Food must always be defrosted by following safe procedures, and should consult appropriate agencies (i.e. Environmental Health Department of the local Borough) for advice if needed. The registered manager must address the following to ensure the safety of residents: Ensure that the bath hoist is serviced and tested as per a maintenance schedule (Repeated requirementtimescale 31/03/08 not met). That the provision of grab handles in the toilets and bathrooms be reviewed to make sure that there is one grab handle on either side of the 31/08/08 12 OP15 17 31/08/08 13 OP15 13(4) 31/08/08 14 OP19 13(4) 30/09/08 Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 32 toilet, to promote the independence of people with poor mobility. Window restrainers that are fitted must be of a type that can only be disabled by a special key/device so that residents are not able to disable the restrainers themselves, unless there has been a risk assessment. The duty roster must be kept updated with the names of staff that actually work in the home, including the names of agency staff, to enable a person looking at the records make a judgment about the staffing levels that the home provides. The recruitment procedure must be followed robustly to make sure that all the checks are carried out before an applicant is offered a job to ensure the safety of people who use the service. The checks should include a full work history (with dates as close to the month as possible), two references and proof of eligibility to work in the UK. There must a record of the induction that staff go through when they start work in the home, to make sure that they receive enough information about the service to work safely with residents Staff must receive training in the management of medication and in fire training to make sure that staff are competent in these areas. The proprietor must make arrangements to have a registered manager for the home as soon as possible to ensure DS0000068639.V365966.R01.S.doc 15 OP27 18(1)(a) 31/08/08 16 OP29 19 30/09/08 17 OP30 17,19 30/09/08 18 OP30 18(1)(c) 30/09/08 19. OP31 8 31/10/08 Tower House II Residential Home Version 5.2 Page 33 that the home is able to meet its stated aims and objectives to a high standard (Repeated requirement-timescale 31/05/08 not met). 20 OP33 24 The home must have in place a fully working quality management system. (Repeated requirementtimescale 31/03/08 not met). Care staff must be supervised at a minimum of six times a year or once every two months (Repeated requirementtimescale 31/03/08 partly met) There must be weekly fire detector tests to make sure that the fire detector system is working properly There must be monthly water temperature checks to make sure that the thermostatic valves are working appropriately and that water is kept at a constant temperature to prevent scalding There must be an up to date fire risk assessment to make sure that the risk of a fire developing is reduced to the minimum level. There must be a comprehensive health and safety risk assessment to address the identifiable risks that people who use the service may face. 31/10/08 21 OP36 18(2) 31/10/08 22 OP38 23(4) 31/08/08 23 OP38 13(4) 31/08/08 24 OP38 23(4) 30/09/08 25 OP38 13(4) 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 34 No. 1 Refer to Standard OP12 Good Practice Recommendations That the life history that is completed for residents is presented in an easier to read format with the use of icons where possible, and is placed at the front of the care plan to bring a real person centred approach to the care plan. The aerial/cable for transmission of cable television should be connected to the television as indicated to give a good quality picture that residents can enjoy. That the home explore the opportunities for outings for residents That staff’s meetings and residents’ meetings are held at the intervals as indicated in the home’s policies and procedures, to offer staff and resident the opportunity to contribute to the running of the home. 2 3 4 OP12 OP12 OP31 Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tower House II Residential Home DS0000068639.V365966.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!